Nursing Homes May Allow Comatose To Die

September 9, 1986|By Rosemary Goudreau of The Sentinel Staff

Nursing homes would be allowed to withhold food and water from patients with terminal illnesses if the state adopts a rule proposed Monday by a committee of administrators, lawyers and patient advocates.

State rules now require nursing homes to force-feed comatose patients who have no chance of recovering, even if their doctors order nourishment stopped at the request of relatives, said Amy Jones of the Department of Health and Rehabilitative Services in Jacksonville.

Nursing homes that stop feeding these types of patients could face lawsuits or criminal charges, said Jones, who oversees the licensing of Florida nursing homes for HRS.

Although state law allows dying people to refuse extraordinary lifesaving measures, ''nutrition and hydration are not extraordinary,'' she said.

''Even the experts can't agree if intravenous or nasogastric feeding is treatment or basic care. If it's treatment, then the resident has the right to refuse it. If it's not treatment, the question is, do they have the right to reject it?''

The proposed rule would allow nursing homes to follow a doctor's order and withhold nourishment for patients who are comatose or unable to make an informed decision. In all cases, death ''must be imminent,'' Jones said.

The change is prompted in part by the case of Thomas Corbett of Fort Myers. In February 1985, Corbett asked a judge to force a nursing home to follow doctors' orders and remove feeding tubes from his wife, who had been comatose for three years and had no chance of recovering. The judge refused and Corbett appealed.

Last April, the 2nd District Court of Appeal ruled that privacy rights guaranteed under the federal and state constitutions include the right to remove feeding tubes from ''persons in a permanent vegetative state with no reasonable prospect of regaining cognitive brain function.''

The unanimous decision said artificial feeding can be stopped if the patient's condition has deteriorated to the point where ''all that remains is the forced function of the body's vital functions.''

Because the case set policy for only one region of the state, HRS is attempting to amend licensing rules so nursing homes statewide can follow a doctor's order and let someone die.

''Right now the rule presumes the nursing home will provide adequate nutrition to all residents,'' Jones said. ''The draft rule we come up with will put the responsibility on the physician and the families or the resident themselves, instead of on the nursing home,'' she said.

The ad hoc committee of nursing home administrators, nurses, lawyers, hospice workers and state officials met in Orlando on Monday to draft the rule. Except for Jones, committee members refused to discuss what action was taken at the meeting.

Jones said participants believe it is ''an emotional and sensitive'' issue that they were not prepared to discuss publicly. A reporter was barred from the meeting.

Before the proposed rule can take effect, it must be approved by HRS Secretary William Page, advertised in the Florida Administrative Weekly and debated in public hearings.